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[Michelle26]

Hi I am after any advice before I speak to my GP again.
Brief history I sm nearly 54, never had children or a hysterectomy.
Suffered with endometriosis for 30yrs so heavy bleeding and extreme pain is usual for me.
Started sequential hrt at 45 due to perimeno symptoms I used patches 2wks of 50mg oestrogen 2wks of combined oestrogen/progesterone.
I continued to have heavy bleeding and pain.
9 months ago at the age if 53 I spoke to my doctor apparently she is a hrt specialist at the surgery, my menopause symptoms had gotten worse hot flushes headache mood swings fatigue etc.
So she suggested continous hrt and placed me on 100mg oestrogen patches and 100mg utrogestan, I am extremely progesterone intolerant, so following advice on here I switched from taking the orally as was getting terrible side effects,and take them vaginally every night.
But unfortunately I am still bleeding pretty heavily with period pains like endometriosis, plus spotting every day.
I do have fibroids, but haven't had any other tests for a few years.
Should i be reducing my oestrogen?
Or switching to the oestrogen gel as i have been advised its good for altering dosage.
Please any advice would be so appreciated 🙏
Thanks Michelle

[CLKD]

Hi!  usually it's the progesterone that causes problems.  When your GP suggests that she is the 'HRT Specialist' what does that mean exactly?  Apparently in our Surgery, but keeping it quiet  , 1 of our lady GPs has been to Dr Newson's Clinic so is more up2date with recent menopause prescription advice. 

It mayB worth your while having a lookC at your surgeries website to see if there is anything mentioned and if not, speak to the Practice Manager for clarification? 

Also put the product names into the search box on the Forum [individually] 2 C if there are threads - make notes ;-).

Could it be that the HRT is aggravating the endometriosis? 

[Michelle26]

Hi thank you for the quick reply.
I am not 100%sure what makes the GPa specialist, but she seems to be recommended for anything hormonal, she has also consultated me on my endometriosis throughput the years.
Yes I was advised the hrt could flare up the endometriosis, but at 54 I was hoping that would be easing a bit!!
And my menopause symptoms were pretty bad so we felt it was worth the risk.
Unfortunately on the continuous hrt I seem to be bleeding more than I have before.
The confusion is they prescribe progesterone to stop bleeding in endometriosis, so I was always advised in was high oestrogen that caused bleeding.
When I was switched to continuous hrt the doctor suggested the daily progesterone should help to stop the daily bleeds.
Thanks for your advice
Michelle

[CLKD]

Make a list to take to the appt and let us know how you get on.

[sheila99]

You can reduce the patch dosage too by cutting a piece off so you don't have to change to gel unless you want to. I would ask for a scan to check things are OK and the fibroids haven't grown. Hopefully someone who knows more about endometriosis will reply but I wonder if it's possible there isn't enough prog in your bloodstream if the endo isn't in your womb?

[sheila99]

Have a look at joziel's Post on this thread
https://www.menopausematters.co.uk/forum/index.php/topic,68048.0/topicseen.html

[joziel]

If you are still in peri (which it sounds like you are), you will bleed on continuous because you'll have breakthrough bleeding. (That's why I stop for a few days once a month to schedule a bleed.)

If dealing with endo pain, you need more progesterone. That can be hefty doses of utrogestan continuously and/or adding in desogestrel POP as well (which ahem ahem is available in pharmacies now ahem).

You can also consider the Mirena coil which will totally stop the bleeding almost always - but don't rely on the Mirena to stop endo pain or endo in other places outside the uterus, take another progestin/progesterone as well, if you do try it. The Mirena will deal just with the bleeding and the uterus, it might not deal with endo elsewhere.... you need systemic progesterone. And your current vaginal utrogestan probably isn't stopping your endo issues either for the same reasons - it's too local and not systemic.

If you can't tolerate oral utrogestan, consider a Mirena coil and also the desogestrel POP for eg.... basically a synthetic progestin which is known to be effective against endo.